FORM ADVUNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION

Complete this Item 2A. only if the person responsible for supervision and compliance does not appear in Item 1J. or 1K.
of Form ADV Part 1A:

A.

Person responsible for supervision and compliance:

Name:

Title:

Telephone:

Fax:

Number and Street 1:

Number and Street 2:

City:

State:

Country:

ZIP+4/Postal Code:

Email address, if available:

If this address is a private residence, check this box:

B.

Bond/Capital Information, if required by your home state

(1)

Name of Issuing Insurance Company:

(2)

Amount of Bond:

$ .00

(3)

Bond Policy Number:

Yes

No

(4)

If required by your home state, are you in compliance with your home state's minimum capital requirements?

Part 1B - Disclosure Questions

BOND DISCLOSURE

For "yes" answers to the following question, complete a Bond DRP.

Yes

No

C.

Has a bonding company ever denied, paid out on, or revoked a bond for you, any advisory affiliate,
or any management person?

JUDGMENT/LIEN DISCLOSURE

For "yes" answers to the following question, complete a Judgment/Lien DRP.

Yes

No

D.

Are there any unsatisfied judgments or liens against you, any advisory affiliate,
or any management person?

ARBITRATION DISCLOSURE

For "yes" answers to the following questions, complete an Arbitration DRP.

E.

Are you, any
advisory affiliate, or any
management person
currently the subject of, or have you, any
advisory affiliate, or any
management person
been the subject of, an arbitration claim alleging damages in excess of $2,500, involving any of the following:

Yes

No

(1)

any investment or an
investment-related
business or activity?

(2)

fraud, false statement, or omission?

(3)

theft, embezzlement, or other wrongful taking of property?

(4)

bribery, forgery, counterfeiting, or extortion?

(5)

dishonest, unfair, or unethical practices?

CIVIL JUDICIAL DISCLOSURE

For "yes" answers to the following questions, complete a Civil Judicial Action DRP.

F.

Are you, any
advisory affiliate, or any
management person
currently subject to, or have you, any
advisory affiliate, or any
management person
been found liable in, a civil,
self-regulatory organization,
or administrative proceeding
involving any of the following:

Yes

No

(1)

an investment or
investment-related
business or activity?

(2)

fraud, false statement, or omission?

(3)

theft, embezzlement, or other wrongful taking of property?

(4)

bribery, forgery, counterfeiting, or extortion?

(5)

dishonest, unfair, or unethical practices?

Part 1B - Business Information

G.

Other Business Activities

(1)

Are you, any advisory affiliate, or any
management person actively engaged in business as a(n) (check all that apply):

If you, any advisory affiliate, or any
management person are actively engaged in any business other than those listed in Item 6.A
of Part 1A or Item 2.G(1) of Part 1B, describe the business and the approximate
amount of time spent on that business:

H.

If you provide financial planning services, the investments made based on those
services at the end of your last fiscal year totaled:

Securities Investments

Non-Securities Investments

Under $100,000

$100,001 to $500,000

$500,001 to $1,000,000

$1,000,001 to $2,500,000

$2,500,001 to $5,000,000

More than $5,000,000

If securities investments are over $5,000,000, how much?
(round to the nearest $1,000,000)

If non-securities investments are over $5,000,000, how much?
(round to the nearest $1,000,000)

I.

Custody

Yes

No

(1)

Advisory Fees

Do you withdraw advisory fees directly from your clients' accounts? If you answered
"yes", respond to the following:

(a)

Do you send a copy of your invoice to the custodian or trustee at the same time
that you send a copy to the client?

(b)

Does the custodian send quarterly statements to your clients showing all disbursements
for the custodian account, including the amount of the advisory fees?

(c)

Do your clients provide written authorization permitting you to be paid directly
for their accounts held by the custodian or trustee?

(2)

Pooled Investment Vehicles and Trusts

(a)

(i)

Do you or a related person act as a general partner,
managing member, or person serving in a similar capacity, for any pooled investment vehicle for which you are the adviser to the pooled investment vehicle, or for which you are the
adviser to one or more of the investors in the pooled investment vehicle? If you answered "yes", respond to the following:

(a)

(ii)

As the general partner, managing member, or person serving in a similar capacity, have you or a related person engaged
any of the following to provide authority permitting each direct payment
or any transfer of funds or securities from the account of the pooled investment vehicle?

Attorney

Independent certified public accountant

Other independent party

Describe the independent party:

For purposes of this Item 2I.2(a), "Independent party" means a person that: (A) is engaged by the investment adviser to act as a gatekeeper for the
payment of fees, expenses and capital withdrawals from the pooled investment; (B) does not control and is not controlled by and is not under
common control with the investment adviser; (C) does not have, and has not had within the past two years, a material business relationship with
the investment adviser; and (D) shall not negotiate or agree to have material business relations or commonly controlled relations with an
investment adviser for a period of two years after serving as the person engaged in an independent party agreement.

(b)

Do you or a related person act as
investment adviser and a trustee for any trust, or act as a trustee for any trust in which your advisory clients are beneficiaries of the trust?

(3)

Do you require the prepayment of fees of more than $500 per client and for six
months or more in advance?

J.

If you are organized as a sole proprietorship, please answer the following:

Yes

No

(1)

(a)

Have you passed, on or after January 1, 2000, the Series 65 examination?

(b)

Have you passed, on or after January 1, 2000, the Series 66 examination and also passed, at any time, the Series 7 examination?

(2)

(a)

Do you have any investment advisory professional designations?

If "no",you do not need to answer Item 2.J(2)(b).

(b)

I have earned and I am in good standing with the organization that issued the following credential:
Certified Financial Planner ("CFP") Chartered Financial Analyst ("CFA") Chartered Financial Consultant ("ChFC") Chartered Investment Counselor ("CIC") Personal Financial Specialist ("PFS") None of the above

(3)

Your Social Security Number:

K.

If you are organized other than as a sole proprietorship, please provide the following: